Aortic Aneurysm Surveillance Research Articles

Enhancing Aortic Aneurysm Surveillance: Transformer NLP for Flagging and Measuring in Radiology Reports

Incidental findings of aortic aneurysms (AAs) often go unreported, and established patients are frequently lost to follow-up. Natural language processing (NLP) offers a promising solution to address these issues. While rule-based NLP methods have shown some success, recent advancements in transformer-based large language models (LLMs) remain underutilized. This study has three aims: (1) to evaluate the effectiveness of our innovative transformer-based NLP pipeline regarding AA detection; (2) to detail the clinical impact by quantifying the number of patients who could benefit from such technology; and (3) to use this information to help coordinate appointments with patients, ensuring proper monitoring and management. 3229 radiology reports were divided into three batches with varying class balance. Each entry was processed through our innovative NLP pipeline, where it was fragmented using regular expression (regex) functions to isolate relevant textual segments. These segments were subsequently processed through our "question and find" (Q&F) function, powered by Google's BERT, a well-established transformer LLM. This Q&F function extracted aortic diameter measurements, flagging measurements that exceeded a predefined threshold. Following detection, we conducted comprehensive chart reviews and contacted primary care providers (PCPs) and patients to categorize aneurysms as "known" or "incidental." We also assessed whether patients with known aneurysms were adhering to regular yearly screenings and coordinated follow-up appointments. Evaluation of the three batches showed high F1 scores: 99.4% (95% CI [98.5-100]), 96.7% (95% CI [95.0-98.2]), and 98.9% (95% CI [98.0-99.6]). Overall measurement accuracy was 98.9% (95% CI [97.6-100]), 99.6% (95% CI [99.3-99.9]), and 98.1% (95% CI [96.8-99.4]). Compared to manual chart reviews, the NLP system demonstrated superior accuracy and fewer errors: 12 vs. 22 (p=0.084), 47 vs. 98 (p=0.000021), and 31 vs. 53 (p=0.015). Of the 412 patients investigated, 58 (14.1%) involved incidental findings, 54 patients (15.3%) were lost to follow-up, 39 patients (55.7%) were successfully contacted, and 37 follow-up appointments (12.1%) were successfully coordinated. The high-performance metrics from our study demonstrate that transformer-based NLP can enhance aortic aneurysm surveillance. Our subsequent comprehensive patient profiling highlighted the need for such a system as a safety net within the electronic medical record (EMR), systematically reviewing radiology reports to detect incidental findings and patients lost to follow-up. This ensures appropriate referrals and monitoring, improving patient outcomes and healthcare efficiency through timely clinical interventions.

Influence of cardiometabolic medications on abdominal aortic aneurysm growth in the UK Aneurysm Growth Study: metformin and angiotensin-converting enzyme inhibitors associated with slower aneurysm growth.

There is a clinical need for treatments that can slow or prevent the growth of an abdominal aortic aneurysm, not only to reduce the need for surgery, but to provide a means to treat those who cannot undergo surgery. Analysis of the UK Aneurysm Growth Study (UKAGS) prospective cohort was conducted to test for an association between cardiometabolic medications and the growth of an abdominal aortic aneurysm above 30 mm in diameter, using linear mixed-effect models. A total of 3670 male participants with data available on abdominal aortic aneurysm growth, smoking status, co-morbidities, and medication history were included. The mean age at recruitment was 69.5 years, the median number of surveillance scans was 6, and the mean(s.e.) unadjusted abdominal aortic aneurysm growth rate was 1.75(0.03) mm/year. In a multivariate linear mixed-effect model, smoking (mean(s.e.) +0.305(0.07) mm/year, P = 0.00003) and antiplatelet use (mean(s.e.) +0.235(0.06) mm/year, P = 0.00018) were found to be associated with more rapid abdominal aortic aneurysm growth, whilst metformin was strongly associated with slower abdominal aortic aneurysm growth (mean(s.e.) -0.38(0.1) mm/year, P = 0.00019), as were angiotensin-converting enzyme inhibitors (mean(s.e.) -0.243(0.07) mm/year, P = 0.0004), angiotensin II receptor antagonists (mean(s.e.) -0.253(0.08) mm/year, P = 0.00255), and thiazides/related diuretics (mean(s.e.) -0.307(0.09) mm/year, P = 0.00078). The strong association of metformin with slower abdominal aortic aneurysm growth highlights the importance of the ongoing clinical trials assessing the effectiveness of metformin with regard to the prevention of abdominal aortic aneurysm growth and/or rupture. The association of angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonists, and diuretics with slower abdominal aortic aneurysm growth points to the possibility that optimization of cardiovascular risk management as part of abdominal aortic aneurysm surveillance may have the secondary benefit of also reducing abdominal aortic aneurysm growth rates.

Evaluation of outcomes and utility of abdominal aortic aneurysm surveillance in octogenarians and nonagenarians.

The aim of this study was to evaluate the utility of our regional abdominal aortic aneurysm (AAA) screening programme in octogenarians and nonagenarians. This was to help decide whether discontinuation might be appropriate in certain instances. Primary outcomes were the number of patients who reached threshold (5.5cm) and the number where intervention was offered. Secondary outcome was cost effectiveness. A retrospective review of a regional AAA surveillance database was carried out to evaluate outcomes. Data collected included patient age, sex, date of first and last scan, initial and latest size of aneurysm, outcome, time under surveillance and total number of scans. Patients were divided into three groups (80-84 years, 85-89 years and 90+ years). The number of patients in this age group was 354. Only 2.0% (n=7) of patients underwent intervention. Threshold size was achieved in 8.3% (n=18), 14.8% (n=18) and 26.7% (n=4), in the age groups 80-84 years, 85-89 years and 90+ years, respectively. Of these patients, operative intervention was possible in 2.8% (n=6), 0.8% (n=1) and 0% (n=0), respectively. A relatively small number of octogenarians and nonagenarians reach the threshold size during surveillance. An even smaller proportion require repair of their aneurysm. While there may be a role for AAA surveillance in octogenarians in highly selected groups, these data should inform the discussions made with individual patients. It should also inform future evaluation of such surveillance.

Incidentally Discovered Cryptogenic Cirrhosis in a Patient with Untreated Celiac Disease

Celiac disease is a common gastrointestinal disorder that primarily manifests its effects on the small bowel. However, the systemic nature of this condition, especially regarding the liver, has been gaining some recognition in the literature. Mild liver disease is common, but few cases progress to cirrhosis. We present a case of an asymptomatic 78-year-old male with a past medical history of longstanding celiac disease, atrial fibrillation, heart failure with preserved ejection fraction, type 2 diabetes mellitus (DM), and chronic kidney disease stage III who underwent a computed tomography (CT) scan for thoracic aortic aneurysm surveillance. Incidentally, on a CT scan, cirrhotic liver morphology was discovered. Right upper quadrant ultrasound confirmed heterogenous echotexture of the liver, consistent with a diagnosis of cirrhosis. Laboratory work-up demonstrated elevated alkaline phosphatase of 171, tissue transglutaminase (TTG) significantly elevated at > 100, and a negative panel of other chronic liver disease labs, including negative anti-smooth muscle antibody, antimitochondrial antibody, liver kidney microsomal antibody, HFE gene, ceruloplasmin, alpha-1-antitrypsin, and alpha-fetoprotein < 2 ng/mL. The patient was not taking any hepatotoxic medications. Although the patient did have type 2 DM, his hemoglobin A1c was well-controlled at 5.9%, and he had no hyperlipidemia and a normal body mass index, making a metabolic etiology of liver disease less likely. The patient had no significant alcohol use, either. The only patient’s major risk factor for liver disease was his untreated celiac disease, diagnosed in infancy. The patient was instructed to avoid any gluten, alcohol, and other hepatotoxic substances and was subsequently followed by a gastroenterologist. The following case report explores the pathogenesis of celiac-associated liver disease and the effect a gluten-free diet can have on the small bowel and the liver.

Use of Natural Language Processing to Describe Screening and Surveillance of Aortic Aneurysms in Ethnic and Racial Minority Groups

Use of Natural Language Processing to Describe Screening and Surveillance of Aortic Aneurysms in Ethnic and Racial Minority Groups

Use of Natural Language Processing to Improve Surveillance of Aortic Aneurysms in Women Deemed Ineligible by Current Guidelines

Use of Natural Language Processing to Improve Surveillance of Aortic Aneurysms in Women Deemed Ineligible by Current Guidelines

The Impact of Abdominal Aortic Aneurysm Surveillance on Octogenarians in Regional Vascular Center

The Impact of Abdominal Aortic Aneurysm Surveillance on Octogenarians in Regional Vascular Center

S2740 Incidentally Discovered Cryptogenic Cirrhosis in a Patient With Untreated Celiac Disease

Introduction: Celiac disease is an autoimmune enteropathy that affects around 1% of the general population and primarily manifests its effects on the small bowel. However, the systemic nature of this condition, especially regarding the liver, has been gaining some recognition in the literature. Mild liver disease is common, but few cases progress to cirrhotic liver disease. In this case report, cryptogenic cirrhosis was incidentally discovered in a patient with a long history of untreated celiac disease with no evidence of any other underlying cause for the cirrhosis. Case Description/Methods: A 78-year-old male with past medical history of longstanding celiac disease, atrial fibrillation, CHF, T2DM, CKD III, and thoracic aortic aneurysm underwent a CT scan for thoracic aortic aneurysm surveillance. Incidentally, on CT scan, a 1.2 cm enhancing focus in left hepatic lobe, cirrhotic liver morphology, and sclerosing mesenteritis were discovered. Initial lab work-up was remarkable for an elevated alkaline phosphatase of 171 and initial tissue transglutaminase (TTG) was >100. Confirmatory ultrasound showed a liver with heterogeneous echotexture, 1.2cm cyst on the left hepatic lobe, and patent main portal vein. Further laboratory workup showed negative anti-smooth muscle antibody, negative antimitochondrial antibody, negative liver kidney microsomal antibody, and alpha-fetoprotein < 2. Patient reported a history of constipation but denied any other gastrointestinal symptoms, including abdominal pain, hematochezia, diarrhea, nausea, or vomiting. Patient had a remote history of alcohol use, with only occasional recreational use at presentation. The patient had never followed a gluten-free diet. (Figure) Discussion: Celiac disease is now thought to be a systemic condition, with up to 30% of patients displaying extraintestinal manifestations. Multiple studies have shown an increased incidence of celiac disease in patients with cirrhosis, and that cessation of gluten can improve not only the small bowel, but also liver function. This suggests that there is utility in monitoring liver function in patients with celiac disease and screening patients with cirrhosis for celiac disease on initial workup. It is also important to inform patients of these connections, as compliance with a gluten-free diet may prevent the progression of the enteropathy and protect its systemic targets.Figure 1.: Sagittal View of Cirrhotic Liver Morphology on Right Upper Quadrant Ultrasound.

A Population-Based Approach to Abdominal Aortic Aneurysm Surveillance Is Associated With Guideline Concordant Care

Most abdominal aortic aneurysms (AAAs) detected incidentally or through targeted screening are small and require surveillance. However, larger AAAs can require vascular surgery (VS) evaluation and intervention. However, prior studies have reported poor follow-up for AAA patients, especially those with small AAAs, and largescale surveillance program outcomes are unreported in U.S.-based healthcare systems. In this study, we have described an established AAA surveillance program and examined its impact on concordance with surveillance guidelines.

Role of volume in small abdominal aortic aneurysm surveillance

ObjectiveCurrent management of small abdominal aortic aneurysms (AAAs) primarily involves serial imaging surveillance of maximum transverse diameter (MTD) to estimate rupture risk. Other measurements, such as volume and tortuosity, are less well-studied and may help characterize and predict AAA progression. This study evaluated predictors of AAA volume growth and discusses the role of volume in clinical practice. MethodsSubjects from the Non-invasive Treatment of Abdominal Aortic Aneurysm Clinical Trial (baseline AAA MTD, 3.5-5.0 cm) with ≥2 computed tomography scans were included in this study (n = 250). Computed tomography scans were conducted approximately every 6 months over 2 years. MTD, volume, and tortuosity were used to model growth. Univariable and multivariable backwards elimination least squares regressions assessed associations with volume growth. ResultsBaseline MTD accounted for 43% of baseline volume variance (P < .0001). Mean volume growth rate was 10.4 cm3/year (standard deviation, 8.8 cm3/year) (mean volume change +10.4%). Baseline volume accounted for 30% of volume growth variance; MTD accounted for 13% of volume growth variance. More tortuous aneurysms at baseline had significantly larger volume growth rates (difference, 32.8 cm3/year; P < .0001). Univariable analysis identified angiotensin II receptor blocker use (difference, −3.4 cm3/year; P = .02) and history of diabetes mellitus (difference, −2.8 cm3/year; P = .04) to be associated with lower rates of volume growth. Baseline volume, tortuosity index, current tobacco use, and absence of diabetes mellitus remained significantly associated with volume growth in multivariable analysis. AAAs that reached the MTD threshold for repair had a wide range of volumes: 102 cm3 to 142 cm3 in female patients (n = 5) and 105 cm3 to 229 cm3 in male patients (n = 20). ConclusionsBaseline AAA volume and MTD were found to be moderately correlated. On average, AAA volume grows about 10% annually. Baseline volume, tortuosity, MTD, current tobacco use, angiotensin II receptor blocker use, and history of diabetes mellitus were predictive of volume growth over time.

Follow-up Compliance is Not Contingent on Insurance Provider, Race, Socioeconomic Status, or Patient Comorbidities in Abdominal Aortic Aneurysm Surveillance

Many vascular surgery patients will be lost to follow-up. We aimed to determine whether socioeconomic status (SES), insurance provider, race, or comorbidities affected the appropriate surveillance of patients with a known abdominal aortic aneurysm (AAA). Patients aged >18 years evaluated in the outpatient setting from October 2009 to January 2020 for AAAs were eligible. Race, gender, insurance status or provider, zip code, comorbidities, age, date of initial presentation, initial AAA size, AAA growth, and subsequent follow-up and imaging studies were collected. Appropriate follow-up was defined by the 2009 Society for Vascular Surgery (SVS) practice management guidelines for AAA surveillance, and a metric of >80% compliance with the guidelines was set. The median household income was obtained from the U.S. Census Bureau. Data analysis was performed using SPSS (IBM Corp, Armonk, NY). The study included 140 patients (Table). Appropriate follow-up and imaging with >80% compliance with guidelines was achieved for 64% of the patients. Aneurysm growth at follow-up had occurred in 94 patients; 59 had undergone repair, 3 of which were emergent. Finally, 35% of patients were ultimately lost to follow-up, even if initially compliant. Mortality was 20%. SES, race, insurance provider, and all comorbid conditions did not significantly affect compliance with appropriate follow-up or loss to follow-up. Rigorous follow-up of patients with AAAs is indicated by the SVS guidelines. Previous studies have identified several at-risk groups for diminished follow-up in vascular pathologies. For surveillance of known AAAs, only 64% of patients achieved 80% compliance with the SVS guidelines for follow-up and 35% of patients were lost to follow-up. No single factor, including insurance provider, SES, race, or comorbidities, significantly contributed to either loss to follow-up or noncompliance with SVS guidelines. Many patients experienced AAA growth and had ultimately required intervention, warranting further study into the explanations for inappropriate/loss to follow-up. Additional education of patients and practitioners alike regarding appropriate follow-up (including improved medical record automation) has the potential to improve surveillance and should also be strongly considered.TablePatient demographicsDemographicPatients, No.Sex Male101 Female39Race White106 Black33 Hispanic0 Asian0 Other1Insurance status Yes133 No6Insurance provider Private28 Medicare101 Medicaid4SES Poor/near poor15 Lower middle class80 Middle class41 Upper middle class4Comorbidity CAD/MI72 CHF21 COPD37 CVA30 PVD31 CKD/ESRD31 DM30 Cancer47CAD, Coronary artery disease; CHF, congestive heart failure; CKD, chronic kidney disease; COPD, chronic obstructive pulmonary disease; CVA, cerebrovascular accident; DM, diabetes mellitus; ESRD, end-stage renal disease; MI, myocardial infarction; PVD, peripheral vascular disease; SES, socioeconomic status. Open table in a new tab

Role of Volume in Small Abdominal Aortic Aneurysm Surveillance

Current management of small abdominal aortic aneurysms (AAAs) primarily involves serial imaging surveillance of maximum transverse diameter (MTD) to estimate rupture risk. Other measurements, such as volume and tortuosity, are less well studied and may help characterize and predict AAA progression. This study evaluated predictors of AAA volume growth and discusses the role of volume in clinical practice.

Optimising intervals for abdominal aortic aneurysm surveillance: A pilot study analysing patient opinion.

Optimising abdominal aortic aneurysm surveillance intervals will improve current surveillance programmes. To the author's knowledge, no known study has exclusively asked patient opinion with regards to their surveillance interval. The aim of this study was to therefore determine a patient's perspective of their optimal intervals, encouraging shared decision-making and creating a patient-focused service. Fifty patients, currently under abdominal aortic aneurysm surveillance, were interviewed. Patients were asked their opinions before and after seeing a patient decision aid. A patient decision aid presents information of risk in an easy-to-understand format. This specific patient decision aid, designed and created for this study, informed patients of the 'risk of exceeding the 5.5 cm surgical threshold' with regards to various surveillance intervals. The chosen optimal surveillance interval was recorded for each patient, and a median interval was calculated for each abdominal aortic aneurysm group. Groups were categorised based upon maximum aortic diameter (3.0-3.4 cm, 3.5-3.9 cm, 4.0-4.4 cm and 4.5-4.9 cm). After assessing the patient decision aid, the median surveillance interval calculated for each abdominal aortic aneurysm group was 24 months (3.0-3.4 cm), 12 months (3.5-3.9 cm), 12 months (4.0-4.4 cm) and 6 months (4.5-4.9 cm), respectively. The majority of patients (78%, n = 39) agreed that the patient decision aid was a useful tool to help make an informed choice. Overall, patients in abdominal aortic aneurysm groups 3.0-3.4 cm and 4.5-4.9 cm would choose to lengthen abdominal aortic aneurysm surveillance intervals. Lengthening the current surveillance intervals to 24 months (currently 12 months) for abdominal aortic aneurysm group 3.0-3.4 cm and to 6 months (currently 3 months) for abdominal aortic aneurysm group 4.5-4.9 cm would not only increase capacity but also reflect the needs and wishes of those using the National Health Service. The use of a patient decision aid is an effective way of communicating, to the patient, the risk of the proposed changes and thus alleviating potential anxiety.

Small Abdominal Aortic Aneurysm Surveillance in the West of Ireland

Objective: Surveillance of small abdominal aortic aneurysms (AAAs) represents a significant workload for vascular surgery departments. The European Society for Vascular Surgery (ESVS) Guidelines advocate three yearly surveillance of AAA measuring 3 – 3.9 cm, yearly for AAA measuring 4 – 4.9 cm, and six monthly thereafter. The aim of this study was to evaluate current surveillance practices in the Vascular Surgery Department at Galway University Hospital (GUH).

Preferences for portable ultrasound devices: a discrete choice experiment among abdominal aortic aneurysm surveillance patients and general ultrasound patients in England

ObjectiveTo undertake an assessment of preferences as to how, where and by whom ultrasounds (US) should be performed in: (1) patients undergoing surveillance of abdominal aortic aneurysm (AAA) size (AAA...

Non-contrast 3D black blood MRI for abdominal aortic aneurysm surveillance: comparison with CT angiography.

Management of abdominal aortic aneurysms (AAAs) is based on diameter. CT angiography (CTA) is commonly used, but requires radiation and iodinated contrast. Non-contrast MRI is an appealing alternative that may allow better characterization of intraluminal thrombus (ILT). This study aims to 1) validate non-contrast MRI for measuring AAA diameter, and 2) to assess ILT with CTA and MRI. 28 patients with AAAs (diameter 50.7 ± 12.3mm) underwent CTA and non-contrast MRI. MRI was acquired at 3T using 1) a conventional 3D gradient echo (GRE) sequence and 2) a 3D T1-weighted black blood fast-spin-echo sequence. Two radiologists independently measured the AAA diameter. The ratio of signal of ILT and adjacent psoas muscle (ILTr = signalILT/signalMuscle) was quantified. Strong agreement between CTA and non-contrast MRI was shown for AAA diameter (intra-class coefficient > 0.99). Both approaches had excellent inter-observer reproducibility (ICC > 0.99). ILT appeared homogenous on CTA, whereas MRI revealed compositional variations. Patients with AAAs ≥5.5cm and <5.5cm had a variety of distributions of old/fresh ILT types. Non-contrast 3D black blood MRI provides accurate and reproducible AAA diameter measurements as validated by CTA. It also provides unique information about ILT composition, which may be linked with elevated risk for disease progression. • Non-contrast MRI is an appealing alternative to CTA for AAA management. • Non-contrast MRI can accurately measure AAA diameters compared to CTA. • MRI affords unique characterization of intraluminal thrombus composition.

M141 Impact Of Beta-blockade On Exercise Capacity And Dynamic Hyperinflation In People With And Without Copd Awaiting Vascular Surgery

Beta-blockers have a key role in the management of heart failure but have been under-utilised in people with COPD due to fear of bronchoconstriction and its impact on symptoms and function. Beta-blockers are also used peri-operatively in people undergoing vascular surgery due to improved cardiac function though this practice is contentious due to a risk of post-operative complications, particularly stroke. As part of a study looking at the impact of beta-blockade in people under abdominal aortic aneurysm surveillance we examined the impact of beta-blockade on CPET variables and dynamic hyperinflation at peak exercise 55 subjects were recruited though only 46 completed incremental CPET off and on beta-blockers. Mean age was 70 (6) years and 42 (91%) were male. IHD or heart failure was diagnosed in 13 people and COPD diagnosed in 7. However, 24/46 (52%) had post-bronchodilator airflow obstruction consistent with COPD (10 mild, 10 moderate and 4 severe). 18 were routinely prescribed beta-blockers (mainly bisoprolol). Those taking beta-blockers stopped treatment for the second CPET and other subjects commenced weight-adjusted bisoprolol before the second CPET. The 25 COPD subjects had a mean FEV 1 of 2.14 (0.62) L, FEV 1 predicted 76 (20)% and FEV 1 /FVC 0.54 (0.11). The main results are shown in the table. Compared with the subjects without COPD at peak exercise the COPD subjects had slightly lower VO2, work and ventilatory equivalents but these did not differ significantly. When beta-blocked both COPD and non-COPD subjects had a lower heart rate (p In an unselected clinic population with arterial vascular disease a majority of people had, mostly undiagnosed, COPD albeit predominantly mild to moderate. Continuation or commencement of beta-blockers had little effect on level of peak exercise or degree of dynamic hyperinflation. This supports the use of beta-blockers in this COPD population, both in a peri-operative setting and for a cardiac indication.

Process support for risk mitigation: a case study of variability and resilience in vascular surgery

ObjectiveTo inform the design of IT support, the authors explored the characteristics and sources of process variability in a surgical care process that transcends multiple institutions and professional boundaries.SettingA case...

RETRACTED: A role for plasma transforming growth factor-β and matrix metalloproteinases in aortic aneurysm surveillance in Marfan syndrome?

We have previously shown that the angiotensin-converting enzyme (ACE) inhibitor perindopril reduced aortic diameter by 3-7mm in Marfan syndrome (MFS) patients. Excessive signalling by the transforming growth factor-beta (TGF-beta) has been implicated in the development of aortic dilatation. We hypothesised that reduction in aortic diameter would correlate with reduction in plasma TGF-beta and matrix metalloproteinase (MMP) levels. 17 MFS patients (aged 33+/-5 (mean+/-SD)) on standard beta-blocker therapy were randomised to also receive perindopril (n=10) or placebo (n=7) for 24 weeks in a double blind study. Aortic root diameters were assessed at four sites via transthoracic echocardiography. Venous blood samples were analysed for latent and active TGF-beta, MMP-2 and MMP-3 levels. Perindopril significantly reduced aortic root diameters relative to placebo in both end-systole and end-diastole (by 1.2-3mm/m(2), p<0.001). In addition, compared to placebo perindopril significantly reduced latent TGF-beta levels by 14.0+/-4.5ng/ml (p=0.01), active TGF-beta levels by 4+/-1ng/ml (p=0.02), MMP-2 levels by 22+/-6ng/ml (p<0.001), and MMP-3 levels by 5+/-1ng/ml (p<0.001). There were moderately strong correlations between the pre/post intervention change in aortic diameters and the change in both latent (r=0.49-0.76, p=0.001-0.04) and active TGF-beta (r=0.59-0.73, p=0.002-0.02), MMP-2 (r=0.63-0.75, p=0.001-0.007), and MMP-3 plasma levels (r=0.81-0.83, p<0.0001). Plasma TGF-beta, MMP-2 and MMP-3 should be further explored in longitudinal trials as potential prognostic indicators of progression of aortic dilatation and response to therapy in MFS.

Radiological Imaging of Aortic Aneurysms

The development of radiological equipment such as MDCT or ultrasonography has increased the diagnostic accuracy of aortic aneurysms and has allowed for improvements in surgical and interventional treatment techniques. However, the mortality and morbidity rate of aortic aneurysms has not decreased significantly. For this reason, there is continuous interest in radiological evaluations of aortic aneurysms. This report reviews the radiological image findings and useful indications for both the diagnosis and surveillance of aortic aneurysms. The popular radiological features of an aortic aneurysm are aortic expansion, combined atherosclerosis, intraluminal mural thrombus, perianeurysmal inflammation and fibrosis, and perianeurysmal hemorrhage due to rupture. As rupture is the most important complication of an aortic aneurysm, various signs of an impending rupture have been suggested. These include the following: a maximum aneurysmal diameter larger than the threshold value, a high expansion rate, periaortic sentinel hemorrhage, and a hyperattenuating crescent in the mural thrombus or aneurysmal wall. To acknowledge the impending rupture of an aortic aneurysm, careful depiction of the clues is indispensable. (Korean Circulation J 2007;37:337-347)